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NOTES 



TAKEN FROM A LECTURE BY 

/ 
DR. MANUEL DAGNINO, 

At the Medical University of Caracas, Capital of Venezuela, 



ON THE 



TREATMENT OF YELLOW FEVER. 



TRANSLATED INTO ENGLISH BY 

DR. ANTONIO DE TEJADA, 

Of Cartagena, U. S. of Colombia, and now of New York. 



The public are respectfully informed that during the prevalence of Yellow 
Fever in the South, one-third of the net proceeds of this pamphlet will be 
devoted entirely to the relief of the sufferers^ and forwarded accordingly. 

Price, 25 Cents. 

This pamphlet is sold in this city at IIUDNUT'S PHARMACY, Herald 
Building; GEORGE SHIELDS', Apothecary and Chemist, 896 Broadway; and 
at Ford's Department at CASWELL, HAZARD & CO.'S, comer Broadway and 
24th Street; and also by all Medical Booksellers. 

u 

Copyright 
National Printing Company, 16, 18, 20 and 22 Chambers Street. 






<lf 



& 



*v 



Treatment of Yellow Fever. 



I divide the Fever into Light and Malignant. 
The malignant can be divided into the fulminating 
and regular, following its ordinary course. Practice 
has taught me that the Climatorial or Yellow Fever 
can be divided, as far as symptoms are concerned, as 
follows : First, Inflammatory ; second, Bilious ; third, 
Ataxic; fourth, Adinamic ; fifth, Catarrh. The pro- 
per distinction of these different varieties occurring 
in the Yellow Fever has assisted me greatly in its 
treatment. I now divide the Yellow Fever into three 
stages, according to its duration. For the benign 
and fulminating there is only one stage. In the 
Fever which lasts five days, as it has done gene- 
rally in the cases coming under my observation, 
there are two stages. When the Fever extends to 
seven, nine, or eleven days, it should be, in my opinion, 
divided into three stages, not mentioning very rare 
cases in which I have seen the Fever last twenty days, 
nor the more frequent cases where it is complicated 
with inflammatory diseases, such as pneumonia, dysen- 



2 TREATMENT OF YELLOW FEVER. 

tery, &c, when it becomes the duty of the practical 
physician to properly determine the course of the 
disease. 

SYMPTOMS OF THE BENIGN FEVER. 

The Yellow Fever presents itself frequently under 
unalarming circumstances, the patient complaining 
simply of a slight indisposition not sufficient to keep 
him from his daily avocations. Of such cases I have 
seen many, notably where a sea-captain came on 
shore for business purposes, and on passing my 
house consulted me as to what I thought ailed him 
slightly, ignoring altogether that he had the Yel- 
low Fever. The symptoms usually complained of 
by the patients are languor, lumbago, slight headache, 
heavy feeling about the head, sometimes slight ver- 
tigo, loss of appetite, more or less thirst, also occasion- 
ally a sense of weight at the stomach. The physician 
will perceive the pulse to be slightly accelerated, there 
being seventy to ninety beats a minute, together with 
a slight rise' in temperature. The eyes are injected, 
the tongue coated, heavy breathing, urine high 
colored and ammoniacal. On closer examination he 
will find that the patient is restless and wakeful, and 
is troubled much by disagreeable dreams. His 









TREA TMENT OE YELLO W EE VER. 3 

spirits will be found slightly depressed, although I 
have met cases in which I have seen the greatest 
tranquillity, the patient attributing all the above 
symptoms to a slight cold. 

The physician who meets with cases in which the 
described symptoms occur should at once take every 
precautionary measure against Yellow Fever, but must 
be careful not to arouse suspicions on the part of his 
patient, or to dispel his pleasant illusions too hastily. In 
this state of the disease the patient generally feels bet- 
ter in the morning, worse during the afternoon and 
night, which condition usually lasts three days, at the 
end of which period there will be a jaundiced appear- 
ance of the esclerotic membrane of the eyes, There 
will be sedimentary deposits in the urine, together with 
bile therein, abundant perspiration, and the patient 
finds himself soon so well again that he cannot believe 
himself to have been ill. 



MALIGNANT OR INSIDIOUS FULMINATING FEVER. 

The above designation is applied to this class of the 
Yellow Fever in consequence of its extreme malignity, 
differing from the other branches of the Fever inas- 
much as it skips over the normal stages and terminates 



4 TREA TMENT OF YELLO W FE VER. 

always in death ; hence it may well be termed perni- 
cious. 

However this may be, the cases which I have ob- 
served of this Fever, and which I term Fulminating, 
have presented to me the following symptoms and 
signs : The patient, following his usual daily avocation, 
is seized suddenly and falls to the ground, as if struck 
by lightning, without time to call upon friends and 
warn them that he feels sick. 

A. — There are cases in which the patient has no time 
to call a doctor ; when he arrives the patient is found 
either dying or dead. I have noticed that those ex- 
posed to the sun — such as soldiers and sailors — are 
mostly subject to such sudden attacks. The bystand- 
ers inform the physician that the patient fell as if 
knocked down by a severe blow, and on examination 
he is found to be slightly swollen, with stertorous 
breathing, coma, and heightened temperature. I may 
here note in this connection that a soldier who had 
succumbed in this manner, for four hours after re- 
tained such bodily heat that considerable doubt and 
apprehension existed as to his being dead previous 
to making his autopsy. 

B. — In other cases there is time to take the first pre- 



TREA TMENT 0F f YELLO W FE VER. 5 

cautionary measures, but all of a sudden, before the 
termination of the first stage, and when least ex- 
pected, the patient takes to his bed and succumbs to 
the disease in a few hours, to the surprise of his at- 
tendants, altogether presenting the symptoms de- 
scribed under A, and in addition accompanied by 
black vomit, together with a highly jaundiced condi- 
tion of the skin. 



The cases referred to have been of robust and san- 
guineous Europeans. After the first twenty-four or 
thirty-six hours, everything progressed well. Cups 
were applied to the neck, and leeches in the region of 
the temples, symptoms of cerebal congestion predomi- 
nating. The patient, although ultimately dying, seem- 
ed to respond to the treatment, nothing occurring to 
make-me apprehensive. I believe that bleeding, freely 
used, was required in these cases. 

In a more extended translation of Dr. Dagnino's 
lecture, which may possibly hereafter appear, it would 
be proper to notice his description of the Regular 
Fever, the prodromes or prelude to the Fever, symp- 
toms of invasion, and description of each of the three 
stages, but all of which, for want of space in a limited 
pamphlet of this nature, I leave out, and pass on to 



6 TEE A TMENT OF YELLO W FE FEE. 

TREATMENT. 

When we suspect an acclimated person is seized with 
Yellow Fever, we proceed in a practical manner, con- 
sulting especially our own experience, to quiet the ap- 
prehensions of the patient, then to place him in the 
proper hygienic condition both for himself and others ; 
and lastly, to discover as far as possible what may have 
given rise to the disease and any former sicknesses he 
may have had, in order to be able to commence treat- 
ment without embarrassment. 

In many cases the patient commences to feel sick 
after a meal, with nausea, weight and pain at the 
stomach, bad taste in the mouth, together with all the 
symptoms of indigestion. In such cases it is well to 
commence treatment with an emetic of Ipecac. If in 
place of these symptoms of indigestion there should 
only be constipation for a few days, treatment can be 
commenced by a dose of castor oil, or it might be 
proper to unite calomel with the oil. 

If the indication should be purging, both from rec- 
tum and mouth, the following prescription may be used : 

Saline mixture, 13 ozs. 

Epsom Salts, 2 ozs. 



TREA TMENT OF YELLO W FE VER. 7 

Tartar Emetic, 2 £ grs. 

Syrup, 2 ozs. 

M. and take two tablespoonfuls every half hour. 

Should there occur no marked indication of purging 
as here mentioned, perspiration should be freely en- 
couraged, for which the footbath may be used for a 
more or less prolonged time, and charged with pul- 
verized mustard, &c, according to the degree of 
headache and other circumstances which the practi- 
tioner will recognize. Immediately after the footbath 
it is advantageous to make use of warm frictions with 
mixed olive oil and alcohol, made after the style 
of Masage, especially over the back, to alleviate the 
pain which there torments the patient so much. Gen- 
erally the first twenty-four hours of the disease should 
be employed applying the applications here named, 
besides mustard plasters in the proper places, warm 
or lukewarm lemonades, and the Potion de Riviero 
with liquor acetate of ammonia, in order to open the 
pores. Generally I have made my patients take from 
three to five drachms of this diffusive medicine every 
twenty-four hours. 

The following is the formula in which the Potion de 
Riverio is prepared : — 



TREATMENT OF YELLOW FEVER. 
POTION DE RIVERIO. 

Take 

Bicarbonate of Potash, \ drachm. 

Water, 14 drachms. 

Simple Syrup, 4 " 

M. and mark "Alkaline Solution, No. 1." 

Take 

Citric Acid, i drachm. 

Lemon Syrup, 4 drachms. 

Water, 14 

M. and mark " Acid Solution, No. 2." 



If in this first stage the pulse and congestion should 
be such as to require bleeding, wet cups and leeches 
can be had recourse -to. The sedatives to the forehead, 
such as ice-water, vinegar, ascetic ether, all seem to 
have a good effect, and are called for. In this period 
the patient may be allowed some orange to eat, but no 
solid alimentation. There are cases in which the pain 
in the back causes much suffering. Then the physician 
will commence by applications of poultices of mustard, 
which, if not sufficient, cupping may be had recourse 
to, which, in some cases, has afforded immediate re- 
lief. 



TREA TMENT OE YELLO W EE VER. 9 

After all this has been done, we proceed to make 
use of the Sulphate of Quinine. I have rarely employed 
it alone, but generally use it in combination with Calo- 
mel and Rhubarb in the following proportions : — 



Take 




Sulphate of Quinine, 


30 grs, 


Calomel, 


25 " 


Rhubarb, 


15 " 



Mix and divide into 20 pills. 

Of these we make the patient take two every three 
hours, or one every two hours ; sometimes we alter- 
nate doses of the Calomel and Rhubarb, according to 
circumstances, viz.: — 

If the bowels are open, diminish the doses, or they 
can be increased if there is a tendency to constipation ; 
and there are cases in which they are discontinued 
after having been used, or where I avoid the Calomel 
from the commencement, which I have done in rare 
cases, such as with women enceinte. Conjointly with 
these pills I continue the use of cold acid drinks, such 
as the Potion de Riviero, orangeades, and lemonades, 
taking care not to overcrowd the stomach, bearing in 
mind that the great thirst of the patient will not be 
quenched by taking large quantities of fluid at one 



i o TREA TMENT OF YELL OW FE VER. 

time. It is necessary to see that the attentions of the 
attendants do not excite vomiting which has not yet 
existed, but which may be superinduced by the least 
imprudence on their part. With this treatment, more 
or less modified, we arrive at the end of the third day 
and to the commencement of the second sta^e of 
the disease. The patient will have taken by this 
time from three to five grams of the sulphate of 
quinine, and from twelve to fifteen grams of the liquid 
acetate of ammonia, when synconism will generally 
have been produced. Now we have to take into 
consideration the strength of the patient, and we 
make use of mineral acids, of the bitters, together 
with generous wines in small quantities. The anti- 
spasmodics will, if indicated, be used, selecting those 
most suitable to the palate of the patient, with a view 
to obviate nausea and vomiting. The patient may be 
allowed the use of various kinds of teas, and cold drinks 
may be continued. With this treatment we may arrive 
to the fifth day and enter into the period of convales- 
cence. Many cases will present themselves in which 
there will be no necessity for recourse to other meas- 
ures than here stated, but unfortunately this does not 
always happen ; when the physician, despairing, puts in 
practice all the therapeutic remedies against the symp- 
toms of this terrible disease. 



TREA TMENT OF YELL O W FE VER. 1 1 

The advice here given is throughout from my own 
experience, and not from any preconceived ideas culled 
from the writings of other practitioners, however 
worthy. I now proceed to enumerate the remedies 
which I have found efficacious : First, for pain in the 
epigastrium, viz., mustard poultices ; the abstraction of 
blood in accordance with the state and strength of 
patient ; applications of flying blisters ; sometimes 
stimulating liniments. Second, Vomit. For this cold 
acid drinks ; pieces of orange ; solution of cream of 
tartar, &c, &c. ; if not counter indicated by carbonate 
of soda or magnesia, with a little opium ; sometimes in 
the bilious form an emetic has seemed to do good and 
afterwards stay the vomiting. If there be constipation, 
a dose of calomel or rhubarb may do good service. 

BLACK VOMIT. 

For this, small repeated doses of lime-water should 
be given, associated with a few drops of laudanum oft 
repeated. Small doses of chlorate of potash and bi- 
carbonate of soda seem to do good. Vegetable and 
mineral acids are often useful. 

HEMORRHAGES. 

If epistasis occurs, it will be treated in the usual way. 



1 2 TEE A TMENT OE YELL O W FE FEE. 

I have never been obliged to tampone the posterior 
narris. For hemorrhages from the stomach, cold drinks 
and mineral acids are used ; other hemorrhages may be 
treated in the usual manner. 

DELIRIUM. 

This symptom or complication is of grave import- 
ance and urgent. Apply cold to the head, revulsives 
to the extremities, depletion of blood from behind the 
ears, opium, and antispasmodics. Everything should 
be put in practice that may be deemed suitable, whether 
there is albumen or not in the urine. 

TREATMENT ACCORDING TO THE DIFFERENT FORMS. 

In accordance with what we have already said of the 
forms of the Fever, I believe that we should pay them 
attention in the consideration of treatment. In the 
form adenamic, sustain the strength by means of the 
mineral acids and bitter tonics employed with prudence. 
Quinine may be also used ; also any form of mercu- 
rials, with caution. The prudent practitioner will be 
careful to bear in mind the form adenamic in order to 
avoid the antiphlogistics, which not only predispose 
the patient to adenemia, but also indirectly precipitates 
it. In this particular it should be noted that the Yel- 



TREA TMENT OF YELLO W FE VER. i 3 

low Fever goes hand in hand with Typhoid, and the 
practical man must not forget the fact. 

ATAXIC OR NERVOUS FORM. 

When certain nervous symptoms predominate, the 
physician will presume that the ataxic form has super- 
vened. This is very important for the treatment. 
Blood extraction should be used with great discretion, 
and every endeavor should be made to help nature as 
far as it is possible. Small doses of opium may be ad- 
ministered to quiet the symptoms. Light antispas- 
modics will be prescribed (chloral may be here used). 
Cold applications to the head will be continued, and 
leeches to the base of the cranium will not be left to the 
last resource. Unfortunately, I have seen in my prac- 
tice that all is useless when the ataxic form reaches the 
form of continuous delirium, with convulsions and al- 
bumen in the urine. Even without these circumstances 
I have lost various cases after employing all the means 
indicated, and, in addition, musk, camphor, castor, etc. 

BILIOUS FORM. 

The Bilious form from the commencement requires 
the use of adequate emetics. I have seen cases in 
which the administration of an emetic on the fourth 



i 4 TREATMENT OF YELLOW FEVER. 

day has very much alleviated the sickness, producing 
bilious vomit of a dark character, abundant diaphoresis, 
disappearance of the cephalalgia, clearing of the head, 
and bringing on rapid convalescence. 



INFLAMMATORY FORM. 

The Inflammatory form calls for the use of anti- 
phlogistics, but it should be recollected that in the 
Yellow Fever from one moment to the other in the best 
constituted and robust person there can come in with 
the typhoid symptoms a surprising condition of adene- 
mia, on which account we should not imitate those 
practitioners who are too sanguine as to the results of 
bleeding. 

CATARRHAL FORM. 

There is very little to be said with respect to this 
form, which is very rare. Warm drinks and sudorifics 
can be employed. 

COMBINATIONS. 

As these forms present themselves combined in 
practice, after having given an account of the princi- 
ples of treatment used, the variations will be met by 



TEE A TMENT OF YELL OW FE FEE. 1 5 

the practitioner, consulting always the state, strength 
of the patient, and the character of the fever present 
at the time. 



COMPLICATIONS. 

Complications will be treated as they present them- 
selves, having always in view the nature of the prin- 
cipal disease. 

With this method of treatment, which for the most 
part is a rational treatment, I have obtained in my prac- 
tice very favorable results. In it there figures only a 
systematic use of the sulphate of quinine, associated 
only with calomel and rhubarb. I ought here to men- 
tion why I have so much faith in these agents, whatever 
may be the form or intensity of the disease. From 
the year 1856 to i860, during which time I practiced 
in the hospitals, I saw put in execution by various 
physicians, and some of them very distinguished, 
divers curative methods, without being able to assign 
to any one of them a position of preference in the 
therapeutics of Yellow Fever. None of these es- 
teemed physicians had any set method or treatment 
from conviction for the Yellow Fever, as it happened 
with other diseases which reigned in the country, such 
as typhoid, dysentery, etc. Alternately I saw put in 



1 6 TREA TMENT OF YELL OW FE VER. 

practice the extraction of blood, the acetate of am- 
monia, the purges, emetics, expectant treatment, and 
mercurials. The sick succumbed in the greater part. 
The autopsies proved nothing particular except a pe- 
culiar state of the liver, which was revealed by dis- 
coloration. As to the rest, the signs were of little 
importance, such as dark contents in the stomach and 
small intestines, coagulated blood in the stomach, red- 
dening of the gastric mucous membrane, which some- 
times was more or less softened, and so forth. It re- 
sults therefore that in the year i860, when I received 
my degree in the Medical University of Caracas, al- 
though I had seen and assisted many cases of Yellow 
Fever, I had no convictions of my own with respect 
to treatment. 

Finding myself therefore frequently before people 
suffering with this disease, and not having as yet suffi- 
cient confidence in my own judgment to separate my- 
self from the classics or the teachers of medicine, I 
continued to put in practice the various methods of 
which I was cognizant, but always with an equal result. 
At the end of two years of this conduct, and led by the 
idea which the Amphitheatre suggested, that the liver 
was the organ or apparatus which most suffered in this 
disease, and led by clinical induction to think that 
Yellow Fever developed itself amongst us by miasma, 



THE A TMENT OF YELL OW FE VER. 1 7 

I endeavored invariably to put in practice the system 
I have propounded. By means of the sulphate of 
quinine I endeavored to operate on the miasma; by 
the calomel and rhubarb, on the liver. Having frequent 
occasion to put in practice my ideas, I was enabled to 
obtain satisfactory results, and if before I saw that the 
sick died at the rate of 60 or 70 per cent, I was at 
last able to persuade myself that with this method 
almost all were saved, that is to say, 00 per cent 





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